Asthma & the Competitive Swimmer

Asthma and the competitive swimmer

Introduction

One in seven children and one in 25 adults in Great Britain have asthma and the number is growing. Thus everyswim squad or club will have a number of asthmatics and it is important for coaches and club officials to have atleast a basic knowledge of the condition.

Asthma is a disorder of the small airways of the lungs which become sensitive to certain triggers which lead to themnarrowing down when they become inflamed. This results in the child or adult becoming wheezy, short of breath orhaving a cough. The underlying cause is partly genetic and partly environmental.

The triggers can vary from patient to patient but often includes colds and viral infections, pollens and moulds, pets,dust, tobacco smoke, emotion and stress, cold air and some medications, such as aspirin. Unfortunately forswimmers, chlorine, used to clean swimming pool water, may be a trigger in some asthmatics. Some people’sairways narrow down during exercise. This is known as exercise-induced asthma (or E.I.A.) and typically comes onafter 5-10 minutes of a training session.

However, swimming is a sport at which asthmatics can and often do excel, as the warm, moist air of the indoor pooldoesn’t trigger an attack. A number of the current British team have asthma and at least six Olympic Gold medallistsin the aquatic events have been suffers of the condition.

How is it diagnosed?

It is possible to measure how quickly someone can expel air from his or her lungs by using a simple hand-held airflow meter. This is known as a ‘peak flow’ test and is a measure of the narrowing of the lung’s airways. There arepredicted peak flow levels for an individual’s sex, age and height. Diagnosis is confirmed if, after exercise ortreatment by inhaler, there is a 15% change to the person’s optimum or predicted peak flow. Peak flow diaries canbe very helpful so that people can detect variations themselves by carrying out regular peak flow tests.

Declaration

No events require athletes to pre-declare their medications. The British Swimming Medical Declaration form has been removed from use and circulation as of 1st January 2016.ASA members are no longer required to complete the form and forms no part of doping control at any event. Please follow this link for further anti-doping advice.

Modern management of asthma is a shared care process with the patient taking some responsibility for theircondition in conjunction with their general practitioner. Nurse-led asthma clinics now occur at most G.P. surgeriesand these help to maintain good control, check inhaler technique and monitor progress.

The peak flow meter, which every asthmatic should have, is the cornerstone of management. This measures theperformance of the lungs and, if charted, gives a clear idea of how well controlled the asthma is. Each asthmasufferer should know what his or her peak flow should be and have a self-management plan for when the conditiondeteriorates.

Types of treatment

There are two types of medication to treat asthma – relievers and preventers. Both are inhalers and they are colourcoded to help identification.

1. Relievers – These inhalers are colour coded blue e.g. salbutamol (Ventolin). They work to open up the airwaysare also known as bronchodilators (or beta 2 agonists).

These are mostly used after symptoms appear but sometimes give brief protection against triggers such as exerciseif they are taken before they appear. It is important NOT to exceed the maximum dose of 2 puffs four times daily,except in an emergency, as high level may trigger a positive Doping Control test.

2. Preventers – if taken regularly these can prevent an asthma attack occurring. They protect the lining of theairways and make them less likely to narrow when triggered.

These should NOT be used for treating an acute attack, as they don’t bring immediate relief. They can take up to 14days to be fully effective when taken regularly. Sodium cromoglycate can be helpful if there is a strong allergiccomponent to the asthma. Other long acting inhalers and oral tablets form a second line treatment if the above donot adequately control the condition.

The Step Care approach to treatment

The current treatment of asthma follows guidelines as laid down by the British Thoracic Association. They take theform of a step care plan, now known as the British Guidelines for the Management of Asthma. This involvesstepping up the level of treatment until satisfactory control is achieved. It is important not to over treat and steppingdown is as important if the asthma is well controlled.

Step 1.

Use an inhaled short acting bronchodilator (such as salbutamol) for symptom relief up to once or twice daily. If youneed more than this move to step 2.

Use an inhaled short acting bronchodilator for symptom relief plus regular high dose inhaled steroid via largevolume spacer or low dose oral steroids or a long acting bronchodilator

For patients who present more of a management problem, two higher steps are available. It is also worthwhile allasthma suffers having the flu vaccine.

How do you know if the asthma is not well controlled?

Measuring the peak flow is one of the best ways of determining good control. Detection of a lower than normal level,or a declining level, should prompt an active review of treatment. The swimmer may complain of nighttime cough orwheezing or may have to get out of a training session due to wheeziness, cough or shortness of breath.

When should the swimmer take their inhaler relative to training or an event?

The reliever inhalers should be taken, if necessary, between 15 and 30 minutes before training or competition toallow maximum time to work properly. One to two puffs are particularly useful in those patients who suffer fromexercise induced asthma.

The swimmer should NOT keep getting in and out of the water for a quick puff of their inhaler. Coaches shouldactively discourage this habit. This usually means that the asthma is not well controlled and the treatment needs tobe reviewed.

However, the swimmer’s ‘rescue’ inhaler should be readily at hand if needed. Swimmers should never shareinhalers.

What to do if a swimmer has an asthmatic attack in the water.

The swimmer concerned should be removed immediately from the water. The swimmer should be reassured andcalmed, encouraged not to hyperventilate and given one to two puffs of their usual reliever inhaler.If there is no response after 5 minutes, this can be repeated.

If, after this has been done and the swimmer is still distressed, unduly short of breath, has a rapid pulse orbecoming blue around the lips (cyanosed), medical help should be sort urgently and, if necessary, an ambulancecalled. Oxygen can be given if available whilst awaiting help.

Useful informationAsthma UK offer advice and publications. They are based at Summit House, 70 Wilson Street, London EC2A 2DB.Tel 020 7786 4900 www.asthma.or.uk You can talk with an asthma nurse specialist on 08457 010203.

Peak flow charts and self-management plans are available through G.P. surgeries and peak flow meters can beobtained on prescription.